Total Hip Replacement

What is a total hip replacement?

A total hip replacement is the surgical removal of the entire hip joint and replacement with an artificial joint called a prosthesis. Your hip joint is formed where your thigh bone (femur) and your hip bone (pelvis) meet. It is a ball and socket joint. The ball-shaped area at the top of your femur fits into a socket-shaped area in your pelvis. Your hip joint also contains ligaments, tendons, cartilage, and lubricating fluid. Total hip replacement can help restore pain-free range of motion and function in a hip joint damaged by arthritis, injury, or other hip problems.

A total hip replacement is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options depending on your condition and specific circumstances. You should consider getting a second opinion about your treatment options before having a total hip replacement.

Types of total hip replacement

The types of total hip replacement procedures include:

• Cemented replacement is a surgery in which your doctor uses special surgical cement to attach the prosthesis to your bone. This procedure is often appropriate for older, less active people or people with weakened bones.
• Uncemented replacement is a surgery in which your doctor uses a prosthesis with a special coating that promotes bone growth into the prosthesis. This procedure has a longer recovery period because it takes time for your bone to grow and securely attach the prosthesis. This bone growth also tends to cause more thigh pain in the months after surgery. Uncemented prostheses are usually more appropriate for younger, active people.
• Hybrid replacement is a surgery in which your doctor uses a combination of cemented and uncemented prostheses. Usually, the femur (ball) part of the prosthesis is cemented and the pelvic (socket) part of the prosthesis is uncemented.

Why is a total hip replacement performed?

A total hip replacement is a major surgical procedure that your doctor may recommend to treat a variety of diseases and conditions of the hip. Your doctor may only consider a total hip replacement for you if other treatment options with less risk of complications are ineffective. Talk with your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend a total hip replacement for severe hip joint damage and pain caused by:

• Bone tumors, which can cause breakdown of the bone
• Hip joint infections, also called septic arthritis
• Hip joint injuries including fractures, torn ligaments, and torn cartilage, which may lead to irreversible joint damage
• Osteoarthritis, or degenerative joint disease. This is the breakdown of cartilage and bones within the joint, resulting in pain, stiffness and swelling. It is the most common reason for a total hip replacement.
• Osteonecrosis, a rare condition involving death of bone
• Rheumatoid arthritis, an autoimmune disease characterized by joint inflammation

How is a total hip replacement performed?

An orthopedic surgeon will lead the surgical team and perform your total hip replacement in a hospital. An orthopedic surgeon is a surgeon who specializes in surgical treatment of diseases of the bones and connective tissues.

Surgical approaches to a total hip replacement

Total hip replacement may be performed using one of the following approaches:

• Minimally invasive surgery involves inserting special instruments and an arthroscope through one (three to six inch) or two (two to three inch) incisions in your hip.  An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your doctor as he or she performs the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less damage to tissues and muscles. Your doctor will make small incisions instead of a larger one used in open surgery. He or she can then thread surgical tools around structures and muscles instead of cutting through or displacing them as in open surgery.
• Open surgery involves making a large 10 to 12 inch incision in your hip. An open surgery incision allows your doctor to directly view and access the surgical area. Open surgery requires a larger incision and involves more cutting and displacement of muscle and other tissues. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery because it causes more damage to tissues. Despite the potential for damage, open surgery may be a safer or more effective method for certain patients.